Provider Demographics
NPI:1578101655
Name:THORNE, SANDRA ELAINE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELAINE
Last Name:THORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 SFC 102
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:AR
Mailing Address - Zip Code:72372-8510
Mailing Address - Country:US
Mailing Address - Phone:870-270-6935
Mailing Address - Fax:
Practice Address - Street 1:242 SFC 102
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:AR
Practice Address - Zip Code:72372-8510
Practice Address - Country:US
Practice Address - Phone:870-270-6935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily